The Significance Of Friction And Shear In The Prevention Of Contemporary Hospital Acquired Pressure Ulcers
Raysa Cabrejo, Sifon Ndon, Ean Saberski, Carolyn Chuang, Henry C. Hsia.
Yale School of Medicine, New Haven, CT, USA.
BACKGROUND: Hospital acquired pressure ulcers (HAPU) are largely preventable yet still common occurrences in hospitals. Using case control methodology, this study sought to better understand contemporary factors contributing to HAPU development. METHODS: A case control study was performed of HAPUs over an 8-month period at Yale New Haven Hospital (YNHH). A Cox Regression Analysis model analyzed the impact of multiple factors on HAPU development including friction and shear, among other Braden score components. A Receiver Operating Characteristic (ROC) curve was calculated to determine the sensitivity and specificity of changes in these factors in predicting HAPU development. RESULTS: On a sample of 9,145 admissions, HAPU incidence was 4.4% over the study period (6.6% per annum). The average hospital day for HAPU development was day 14.0 (± 19.0). The Cox Regression Analysis demonstrated that the friction and shear component of Braden scores had a hazard ratio of 26.81 (p-value<0.01, CI: 15.49-46.40), meaning an increase of 1.0 in the standard deviation of the friction and shear component was associated with 26.81 fold increase in HAPU risk. Change in the friction and shear component was the most predictive factor with a high ROC curve area of 0.851±0.01 (CI: 0.833-0.869). CONCLUSION: Change in the friction and shear component of Braden scores appears to be the most significant factor preceding HAPU development at YNHH. Efforts to place more focus on preventing changes to this factor may help decrease HAPU risk for future patients.
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